Alteplase interactions
Full monograph for AlteplaseCheck it against another medicine
Medicines
97 documented
Mechanism
| Medicine | Severity | Mechanism | Effect | Sources |
|---|---|---|---|---|
| Acalabrutinib | Major | Synergy | Coadministration of acalabrutinib and drugs that interfere with platelet function or coagulation may potentiate the risk of bleeding complications. | 3 sources — open the full entry |
| Allium cepa + Heparin + Allantoin | Major | Synergy | Although this combination is used therapeutically and recommended for certain indications (e.g., acute myocardial infarction, pulmonary embolism), fibrinolytic… | 12 sources — open the full entry |
| Apixaban | Major | Synergy | Concomitant use of apixaban with other agents that alter hemostasis such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), platelet aggregation… | 39 sources — open the full entry |
| Betrixaban | Major | Synergy | Concomitant use of betrixaban with other agents that alter hemostasis such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), platelet aggregation… | 39 sources — open the full entry |
| Bivalirudin | Major | Synergy | The concomitant administration of thrombin inhibitors and thrombolytic agents may increase the risk of bleeding complications. Intracranial bleeding has been… | 1 sources — open the full entry |
| Cabozantinib | Major | Synergy | Coadministration of cabozantinib and drugs that interfere with platelet function or coagulation may potentiate the risk of bleeding complications. Treatment… | 39 sources — open the full entry |
| Dabigatran Etexilate Mesylate | Major | Synergy | Drugs that can affect hemostasis such as glycoprotein IIb/IIIa inhibitors, thienopyridine antiplatelet agents, unfractionated and low molecular weight… | 3 sources — open the full entry |
| Dalteparin Sodium | Major | Synergy | Drugs that can affect hemostasis such as dextran, platelet inhibitors, thrombin inhibitors, thrombolytic agents, or other anticoagulants may potentiate the… | 7 sources — open the full entry |
| Dasatinib | Major | Synergy | Coadministration of dasatinib and drugs that interfere with platelet function or coagulation may potentiate the risk of bleeding complications. Treatment with… | 5 sources — open the full entry |
| Deferasirox | Major | Synergy | Coadministration with drugs that have known ulcerogenic or hemorrhagic potential may increase the risk of gastrointestinal bleeding associated with the use of… | 3 sources — open the full entry |
| Enoxaparin Sodium | Major | Synergy | Drugs that can affect hemostasis such as dextran, platelet inhibitors, thrombin inhibitors, thrombolytic agents, or other anticoagulants may potentiate the… | 7 sources — open the full entry |
| Eptifibatide | Major | Synergy | The intended and unintended effects of glycoprotein IIb/IIIa inhibitors and thrombolytic agents are additive, such that there is an increased frequency of… | 4 sources — open the full entry |
| Fondaparinux Sodium | Major | Synergy | Drugs that can affect hemostasis such as dextran, platelet inhibitors, thrombin inhibitors, thrombolytic agents, or other anticoagulants may potentiate the… | 7 sources — open the full entry |
| Heparin Sodium | Major | Synergy | Although this combination is used therapeutically and recommended for certain indications (e.g., acute myocardial infarction, pulmonary embolism), fibrinolytic… | 12 sources — open the full entry |
| Ibrutinib | Major | Synergy | Coadministration of ibrutinib and drugs that interfere with platelet function or coagulation may potentiate the risk of bleeding complications. | 6 sources — open the full entry |
| Ponatinib Hydrochloride | Major | Synergy | Coadministration of ponatinib and drugs that interfere with platelet function or coagulation may potentiate the risk of bleeding complications. Treatment with… | 3 sources — open the full entry |
| Prasugrel Hydrochloride | Major | Synergy | Concomitant use of prasugrel with other agents that affect hemostasis such as anticoagulants, platelet inhibitors, thrombin inhibitors, thrombolytic agents… | 2 sources — open the full entry |
| Ramucirumab | Major | Synergy | Coadministration of ramucirumab and drugs that interfere with platelet function or coagulation may potentiate the risk of bleeding complications. Ramucirumab… | 2 sources — open the full entry |
| Regorafenib Monohydrate | Major | Synergy | Coadministration of regorafenib and drugs that interfere with platelet function or coagulation may potentiate the risk of bleeding complications. Treatment… | 5 sources — open the full entry |
| Rivaroxaban | Major | Synergy | Concomitant use of rivaroxaban with other agents that alter hemostasis such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), platelet aggregation… | 1 sources — open the full entry |
| Tirofiban Hydrochloride | Major | Synergy | The intended and unintended effects of glycoprotein IIb/IIIa inhibitors and thrombolytic agents are additive, such that there is an increased frequency of… | 4 sources — open the full entry |
| Warfarin Sodium | Major | Synergy | Although warfarin is commonly administered for the prevention of embolism in certain patients following thrombolytic therapy (e.g., myocardial infarction)… | 47 sources — open the full entry |
| Aminocaproic acid | Moderate | Antagonism | Coadministration of an antifibrinolytic agent (e.g., aminocaproic acid, tranexamic acid, aprotinin) in combination with a tissue plasminogen activator (t-PA)… | 4 sources — open the full entry |
| Aspirin | Moderate | Synergy | Drugs that inhibit platelet function may increase the risk of bleeding when administered prior to, during, or after thrombolytic therapy. | 8 sources — open the full entry |
| Aspirin + Dipyridamole | Moderate | Synergy | Drugs that inhibit platelet function may increase the risk of bleeding when administered prior to, during, or after thrombolytic therapy.2 documented mechanisms | 8 sources — open the full entry |
| Benzoic Acid + Salicylic Acid | Moderate | Synergy | Drugs that inhibit platelet function may increase the risk of bleeding when administered prior to, during, or after thrombolytic therapy. | 8 sources — open the full entry |
| Betamethasone Dipropionate + Salicylic Acid | Moderate | Synergy | Drugs that inhibit platelet function may increase the risk of bleeding when administered prior to, during, or after thrombolytic therapy. | 8 sources — open the full entry |
| Bromfenac Sodium | Moderate | Synergy | Systemically and topically administered nonsteroidal anti-inflammatory drugs (NSAIDs) may potentiate the risk of bleeding in patients treated with… | 3 sources — open the full entry |
| Captopril | Moderate | Synergy | Coadministration of a tissue plasminogen activator with an angiotensin enzyme converting (ACE) inhibitor may increase the risk of angioedema and anaphylactoid… | 6 sources — open the full entry |
| Cetalkonium Chloride + Choline Salicylate | Moderate | Synergy | Drugs that inhibit platelet function may increase the risk of bleeding when administered prior to, during, or after thrombolytic therapy. | 8 sources — open the full entry |
| Cilostazol | Moderate | Synergy | Drugs that inhibit platelet function may increase the risk of bleeding when administered prior to, during, or after thrombolytic therapy. | 8 sources — open the full entry |
| Citalopram Hydrobromide | Moderate | Synergy | Serotonin reuptake inhibitors (SRIs) may potentiate the risk of bleeding in patients treated with ulcerogenic agents and agents that affect hemostasis such as… | 42 sources — open the full entry |
| Clobetasol Propionate + Salicylic Acid | Moderate | Synergy | Drugs that inhibit platelet function may increase the risk of bleeding when administered prior to, during, or after thrombolytic therapy. | 8 sources — open the full entry |
| Clomipramine Hydrochloride | Moderate | Synergy | Serotonin reuptake inhibitors (SRIs) may potentiate the risk of bleeding in patients treated with ulcerogenic agents and agents that affect hemostasis such as… | 42 sources — open the full entry |
| Clopidogrel + Aspirin | Moderate | Synergy | Drugs that inhibit platelet function may increase the risk of bleeding when administered prior to, during, or after thrombolytic therapy.2 documented mechanisms | 8 sources — open the full entry |
| Clopidogrel Bisulphate | Moderate | Synergy | Drugs that inhibit platelet function may increase the risk of bleeding when administered prior to, during, or after thrombolytic therapy. | 8 sources — open the full entry |
| Coal Tar + Precipitated Sulphur + Salicylic Acid | Moderate | Synergy | Drugs that inhibit platelet function may increase the risk of bleeding when administered prior to, during, or after thrombolytic therapy. | 8 sources — open the full entry |
| Desvenlafaxine Succinate | Moderate | Synergy | Serotonin reuptake inhibitors (SRIs) may potentiate the risk of bleeding in patients treated with ulcerogenic agents and agents that affect hemostasis such as… | 42 sources — open the full entry |
| Dexibuprofen | Moderate | Synergy | Systemically and topically administered nonsteroidal anti-inflammatory drugs (NSAIDs) may potentiate the risk of bleeding in patients treated with… | 3 sources — open the full entry |
| Dexketoprofen | Moderate | Synergy | Systemically and topically administered nonsteroidal anti-inflammatory drugs (NSAIDs) may potentiate the risk of bleeding in patients treated with… | 3 sources — open the full entry |
| Diclofenac Diethylamine + Mephenesin + Menthol + Methyl Salicylate + Turpentine Oil | Moderate | Synergy | Systemically and topically administered nonsteroidal anti-inflammatory drugs (NSAIDs) may potentiate the risk of bleeding in patients treated with… | 3 sources — open the full entry |
| Diclofenac Potassium | Moderate | Synergy | Systemically and topically administered nonsteroidal anti-inflammatory drugs (NSAIDs) may potentiate the risk of bleeding in patients treated with… | 3 sources — open the full entry |
| Diclofenac Sodium | Moderate | Synergy | Systemically and topically administered nonsteroidal anti-inflammatory drugs (NSAIDs) may potentiate the risk of bleeding in patients treated with… | 3 sources — open the full entry |
| Diclofenac Sodium (Ophthalmic) | Moderate | Synergy | Systemically and topically administered nonsteroidal anti-inflammatory drugs (NSAIDs) may potentiate the risk of bleeding in patients treated with… | 3 sources — open the full entry |
| Diclofenac Sodium + Lidocaine Hydrochloride | Moderate | Synergy | Systemically and topically administered nonsteroidal anti-inflammatory drugs (NSAIDs) may potentiate the risk of bleeding in patients treated with… | 3 sources — open the full entry |
| Diclofenac Sodium + Methyl Salicylate + Linseed Oil + Menthol | Moderate | Synergy | Systemically and topically administered nonsteroidal anti-inflammatory drugs (NSAIDs) may potentiate the risk of bleeding in patients treated with… | 3 sources — open the full entry |
| Diclofenac Sodium + Misoprostol | Moderate | Synergy | Systemically and topically administered nonsteroidal anti-inflammatory drugs (NSAIDs) may potentiate the risk of bleeding in patients treated with… | 3 sources — open the full entry |
| Dipyridamole | Moderate | Synergy | Drugs that inhibit platelet function may increase the risk of bleeding when administered prior to, during, or after thrombolytic therapy. | 8 sources — open the full entry |
| Dithranol + Boric Acid + Salicylic Acid | Moderate | Synergy | Drugs that inhibit platelet function may increase the risk of bleeding when administered prior to, during, or after thrombolytic therapy. | 8 sources — open the full entry |
| Duloxetine Hydrochloride | Moderate | Synergy | Serotonin reuptake inhibitors (SRIs) may potentiate the risk of bleeding in patients treated with ulcerogenic agents and agents that affect hemostasis such as… | 42 sources — open the full entry |
Conditions
Conditions in which Alteplase needs care, as documented in this source.
Hemorrhagic Disorders
MajorThe use of thrombolytics is contraindicated in patients with an active bleed (internal), trauma/surgery (recent CPR/intracranial/intraspinal surgery within 2 months), bleeding diathesis, history of cerebrovascular (CV) accident, intracranial defect (aneurysm, arteriovenous malformation, neoplasm), or severe uncontrolled arterial hypertension (SBP>180/DBP>110). Risk versus benefit should be carefully considered in the following conditions and thrombolytic therapy administered with caution in patients with recent (10 days) serious GI bleed or recent (10 days) surgical procedure (coronary bypass graft, obstetrical delivery, organ biopsy, puncture of noncompressible vessel), left heart thrombus, subacute bacterial endocarditis, hemostatic defect, CV disease, diabetic hemorrhagic retinopathy, or pregnancy. Clinical monitoring of hematopoietic, bleeding and coagulation functions is recommended prior to initiation of thrombolytic therapy. Measures of fibrinolytic activity and/or coagulation functions during infusion do not correlate with efficacy or risk of bleeding.
29 sources
- Kase CS, Pessin MS, Zivin JA, del Zoppo GJ, Furlan AJ, Buckley JW, Snipes RG, LittleJohn JK "Intracranial hemorrhage after coronary thrombolysis with tissue plasminogen activator." Am J Med 92 (1992): 384-90
- Califf RM, Topol EJ, George BS, Boswick JM, Abbottsmith C, Sigmon KN, Candela R, Masek R, Kereiakes D, O'Neill WW, et al. "Hemorrhagic complications associated with the use of intravenous tissue plasminogen activator in treatment of acute myocardial infarction." Am J Med 85 (1988): 353-9
- Topol EJ, Herskowitz A, Hutchins GM "Massive hemorrhagic myocardial infarction after coronary thrombolysis." Am J Med 81 (1986): 339-43
- Dabbs CK, Aaberg TM, Aguilar HE, Sternberg P, Jr Meredith TA, Ward AR "Complications of tissue plasminogen activator therapy after vitrectomy for diabetes." Am J Ophthalmol 110 (1990): 354-60
- Fromm RE, Hoskins E, Cronin L, Pratt CM, Spencer WH, Roberts R "Bleeding complications following initiation of thrombolytic therapy for acute myocardial infarction: a comparison of helicopter- transported and nontransported patients." Ann Emerg Med 20 (1991): 892-5
- Kase CS, O'Neal AM, Fisher M, Girgis GN, Ordia JI "Intracranial hemorrhage after use of tissue plasminogen activator for coronary thrombolysis." Ann Intern Med 112 (1990): 17-21
- Maggioni AP, Franzosi MG, Santoro E, White H, Van de Werf F, Tognoni G "The risk of stroke in patients with acute myocardial infarction after thrombolytic and antithrombotic treatment. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico II (GISSI-2), andThe International Study Group." N Engl J Med 327 (1992): 1-6
- Garcia-Rubira JC, Lopez V, Rojas J, Garcia-Martinez JT, Cruz JM "Thrombolytic therapy soon after left heart catheterization--is it safe?" Intensive Care Med 17 (1991): 501-3
Show all 29 sourcesShow fewer sources
- Tisdale JE, Colucci RD, Ujhelyi MR, Kluger J, Fieldman A, Chow MS "Evaluation and comparison of the adverse effects of streptokinase and alteplase." Pharmacotherapy 12 (1992): 440-4
- Brenot F, Pacouret G, Meyer G, Sors H, Charbonnier B, Simonneau G "Adverse reactions with anistreplase." Lancet 338 (1991): 114-5
- McNeill AJ, Roberts MJ, Wilson CM, Dalzell GW, Dickey W, Flannery DJ, Campbell NP, Khan MM, Molajo AO, Patterson GC, et al. "Anistreplase in early acute myocardial infarction and the one-year follow-up." Int J Cardiol 31 (1991): 39-49
- Hirsch DR, Goldhaber SZ "Bleeding time and other laboratory tests to monitor the safety and efficacy of thrombolytic therapy." Chest 97 (1990): s124-31
- Levine SR, Brott TG "Thrombolytic therapy in cerebrovascular disorders." Prog Cardiovasc Dis 34 (1992): 235-62
- Hanaway J, Torack R, Fletcher AP, Landau WM "Intracranial bleeding associated with urokinase therapy for acute ischemic hemispheral stroke." Stroke 7 (1976): 143-6
- Erlemeier HH, Zangemeister W, Burmester L, Schofer J, Mathey DG, Bleifeld W "Bleeding after thrombolysis in acute myocardial infarction." Eur Heart J 10 (1989): 16-23
- Schneeman NJ, Stein EM "Thrombolytic therapy and gastrointestinal bleeding." Am Fam Physician 43 (1991): 53-6,
- Haugeberg G, Bonarjee V, Dickstein K "Fatal intrathoracic haemorrhage after cardiopulmonary resuscitation and treatment with streptokinase and heparin." Br Heart J 62 (1989): 157-8
- Berridge DC, Makin GS, Hopkinson BR "Local low dose intra-arterial thrombolytic therapy: the risk of stroke or major haemorrhage." Br J Surg 76 (1989): 1230-3
- De Jaegere PP, Arnold AA, Balk AH, Simoons ML "Intracranial hemorrhage in association with thrombolytic therapy: incidence and clinical predictive factors." J Am Coll Cardiol 19 (1992): 289-94
- Aldrich MS, Sherman SA, Greenberg HS "Cerebrovascular complications of streptokinase infusion." JAMA 253 (1985): 1777-9
- London NJ, Williams B, Stein A "Systemic thrombolysis causing haemorrhage around a prosthetic abdominal aortic graft." BMJ 306 (1993): 1530-1
- McLeod DC, Coln WG, Thayer CF, Perfetto EM, Hartzema AG "Pharmacoepidemiology of bleeding events after use of r-alteplase or streptokinase in acute myocardial infarction." Ann Pharmacother 27 (1993): 956-62
- "Product Information. Eminase (anistreplase)." SmithKline Beecham (2001):
- "Product Information. Abbokinase Open-Cath (urokinase)." Abbott Pharmaceutical (2022):
- "Product Information. Activase (alteplase)." Genentech (2001):
- "Product Information. Streptase (streptokinase)." Astra-Zeneca Pharmaceuticals (2001):
- Wagstaff AJ, Gillis JC, Goa KL "Alteplase - a reappraisal of its pharmacology and therapeutic use in vascular disorders other than acute myocardial infarction." Drugs 50 (1995): 289-316
- Levine MN, Goldhaber SZ, Gore JM, Hirsh J Califf RM "Hemorrhagic complications of thrombolytic therapy in the treatment of myocardial infarction and venous thromboembolism." Chest 108 Suppl (1995): s291-301
- "Product Information. Retavase (reteplase)." Boehringer Mannheim (2001):